The use of chemical peels, termed chemoexfoliation, to rejuvenate skin is one of the most powerful tools available to facial plastic surgeons. The concept of using a chemical agent to resurface the skin for purposes of improved appearance dates as far back as ancient times. In fact, it has been reported that Cleopatra routinely bathed in sour goat’s milk to help beautify her skin. Unbeknownst to her, the lactic acid contained in the milk was the active ingredient providing her with a rejuvenating peel.
The modern era of chemical peeling began at the turn of the century when George Miller MacKee, a dermatologist, began using phenol to treat facial scars. Over the ensuing decades, peeling was popularized by lay operators rather than by physicians. At the time, formulas were considered closely guarded secrets. Eventually, these procedures began to attract widespread attention because of the remarkable results that were achieved.
Scientific investigation was finally undertaken by plastic surgeons and dermatologists who legitimized their use for cosmetic enhancement of the face. This included delineating the indications and limitations of the procedures and improving their safety and efficacy.
Currently, a number of categories of chemical peeling agents available for rejuvenating the skin can be found. These range from superficial formulations available over-the-counter to deep chemical agents that should only be applied by a physician in a controlled setting. When used in the proper setting with appropriate technique, nearly all of these products have proven successful in improving quality and appearance of facial skin.
The goal of chemical peeling is to remove a predictable uniform thickness of damaged skin. Normal wound healing and skin rejuvenation follow while complications such as scarring and pigmentary changes are minimized.